Healthy Ageing Paper

National Inquiry into Employment
Discrimination Against Older Australians
and Australians with Disability
HEALTHY AGEING PAPER
May 2016
HEALTHY AGEING PAPER
May 2016
ABN 47 996 232 602

Level 3, 175 Pitt Street, Sydney NSW 2000
GPO Box 5218, Sydney NSW 2001
General enquiries 1300 369 711
Complaints info line 1300 656 419
TTY 1800 620 241
Australian Human Rights Commission
Healthy Ageing, Willing to Work National Inquiry 2016
Table of Contents
1 Introduction .............................................................................................................. 3
1.1 Recommendations ............................................................................................... 3
2 Health and workforce participation of older workers ............................................ 4
2.1 The impact of chronic conditions on workforce participation .......................... 5
2.2 Trends and projections ....................................................................................... 7
2.3 The impact of ageism and negative assumptions ............................................. 8
3 The case for wellbeing and longer working lives .................................................. 9
3.1 Government .......................................................................................................... 9
3.2 Business ..............................................................................................................11
3.3 Individuals ...........................................................................................................12
3.4 International examples .......................................................................................15
4 What can be done to facilitate longer, healthier working lives? ..........................16
4.1 Public education campaign - reinforcing the importance of healthy ageing ..16
4.2 Facilitating good health in the workplace .........................................................17
4.3 Organisational support and workplace adjustments .......................................18
2
1 Introduction
This paper expands on the evidence presented in the Willing to Work Inquiry regarding the
link between health and workforce participation. As a critical factor of ongoing workforce
participation it is important to analyse how improvements in health and related workplace
practices can facilitate and enhance policies aimed at increasing the workforce participation
of older people.
Significantly, current evidence shows that:

People with fair or poor health status are less likely to be employed. This effect is
felt more acutely by older workers and those with multiple chronic health conditions.
Those who retire for health reasons, retire on average earlier than those retiring for
any other reason.
There is a significant cost to government, business and individuals, as a result of this
reduced workforce participation.
The National prevalence survey of age discrimination in the workplace asked Australians
aged 50 years and older who did not participate in the workforce in the previous two years,
but would have liked to, to provide their reasons for not working. The most common reason
reported related to health (44%).1
The Report of the Willing to Work Inquiry, in keeping with its terms of reference, made 56
recommendations aimed at reducing the prevalence of age and disability discrimination in
employment and overcoming barriers to work currently experienced by older Australians and
Australians with disability. The full report is available at
www.humanrights.gov.au/news/stories/willing-work-national-report-released
The Report includes five recommendations specifically related to healthy ageing. These are
listed below numbered as they appear in the Willing to Work Report. Taken together the aim
of these recommendations is to reduce the prevalence of chronic health conditions and
facilitate better support for people with chronic health conditions so that they can remain in
the workforce for longer.
1.1 Recommendations
Recommendation 13: That the Australian Government develop and implement a national
healthy ageing strategy to promote evidence-based preventative health practice
particularly in the employment context, and improve access to workplace adjustments.
This strategy is to be supported and overseen by an expert advisory panel. As part of this
strategy the government will actively engage industry groups, peak bodies and trade
unions.
Recommendation 14: That the Australian Government develop a national public

education campaign that reinforces the importance of healthy ageing, and in particular,
emphasises the relationship between health and work.
Recommendation 15: That the Australian Government investigate the provision of tax or
other financial incentives to encourage business and employers to adopt health and
wellbeing initiatives e.g. extend the fringe benefits tax exemption to off-site fitness
services, and broaden the Medicare benefits scheme to exercise programs for people with
chronic conditions.
3
Recommendation 16: That the Australian Government establish and fund a healthy and
productive workers initiative, to be administered jointly by government departments
including the Department of Health and Department of Employment to actively promote
evidence-based workplace health programs, disseminate information and showcase good
practice.
Recommendation 17: That to support continuing workforce participation and to improve

access to workplace adjustments for people with chronic health conditions, the Australian
Government:
expand the Employment Assistance Fund to include training for managers and
co-workers about employees with chronic health conditions
develop information and resources provided by JobAccess that specifically
address workplace adjustments for employees with chronic health conditions
review the current EAF guidelines to ensure they do not exclude people with
chronic health conditions from accessing workplace adjustments.
The first two sections of this paper provide an overview of the impact of health on workforce
participation and highlight the case for wellbeing from individual, business and government
perspectives. The final section of this paper presents potential ways to facilitate longer and
healthier working lives.
2 Health and workforce participation of older workers
Poor health is a leading cause of premature and involuntary exit from the workforce. It has
been reported that 50% of men and 20% of women who retire from full-time work before the
age of 55 years do so because of ill health.2
Recent research by AMP and the National Centre for Social and Economic Modelling
(AMP.NATSEM) has shown that older Australians with a self-rated health status of fair or
poor are significantly less likely to remain in the workforce compared to those who rate their
health as good or excellent.3 The decrease in workforce participation with worsening health
status is shown in Figure 1.
Figure 1: Proportion employed either full or part-time by health
status (2011-12)
80
72
70
Proportion employed (%)
62
60 55
50 44
42 41
40 35 Excellent/very good
30 25 Good
23
18 Fair/poor
20 15
9
10
0
Male 60-64 Male 65-69 Female 60-64 Female 65-69
Age, Gender, Health Status

Source: AMP.NATSEM4
4
The relationship between health and workforce participation is complex, and influenced by
other factors such as job design, level of education, marital status, physical activity and body
mass index.5 For example in terms of the influence of geographic location, a study in 2013
concluded that men and women living outside major cities were more likely to be retired for
health reasons.6
2.1 The impact of chronic conditions on workforce participation
The number of reported chronic health conditions tends to increase with age. The Australian
Institute of Health and Welfare estimates that 54% of 55-64 year olds have one or more
chronic health conditions, compared to 21% of people aged 25-34 years.7 This is significant
because chronic health conditions are particularly implicated in reduced workforce
participation and premature retirement.
As shown in Figure 2, people with a chronic condition across all age groups are less likely to
be in employment and more likely to be not in the labour force (NILF), than those without a
chronic condition.
Figure 2: Workforce partcipation by age group and chronic
condition status
Employed no chronic condition Employed chronic condition
NILF no chronic condition NILF chronic condition
Unemployed no chronic condition Unemployed chronic condition
90%
80%
70%
60%
Percentage (%)
50%
40%
30%
20%
10%
0%
25-34 35-44 45-54 55-64
Age group (years)
Source: Australian Institute of Health and Welfare8
The difference in workforce participation between persons with and without a chronic
condition increases with age, becoming most pronounced for people aged 55-64 years. This
means that not only does the prevalence of chronic conditions increase with age, the
negative impact on workforce participation is also more acutely felt by older people.
For example, the difference between those employed without and with a chronic condition
between the ages of 25-34 is 5.6 percentage points (83.3% compared to 77.7%), while the
difference for those aged 55-64 years is 17.6 percentage points (64.1% compared to 46.5%).
Similarly, there is a 3.9 percentage point difference (17.2% compared to 13.3%) for those
aged 25-34 years with and without a chronic condition not in the labour force, compared to a
difference of 18.5 percentage points for those aged 55-64 years (52.8% compared to 34.3%).
5
Co-morbidity of chronic conditions is a strong predictor of workforce participation, with the

likelihood of workforce participation decreasing as the number of co-morbidities increases;
this is shown in Figure 3. This is important to note because of older people with a chronic
health condition, the majority tend to have more than one condition.9
Figure 3: Workforce participation of those with multiple chronic

health conditions (45-64 years old, 2009)
83%
90%
71%
80%
62%
Percentage (%)
70%
49%
60%
50%
35%
34%
32%
31%
28%
40%
23%
19%
17%
30%
10%
20%
6%
N/A
10%
0%
No chronic health 1 2 3 4+
condition
Number of chronic health conditions
In the labour force Not in the labour force due to ill health
Not in the labour force due to other reasons
Source: Schofield10
Schofield et al. estimates 347,000 people aged 45-64 years are out of the workforce due to a
chronic condition.11 In this group the five most prevalent chronic conditions reported, being
back problems, arthritis, mental and behavioural disorders, cardiovascular disease and
depression, account for approximately 61% of those out of the workforce due to chronic
conditions.12
A number of common chronic conditions are also highly work limiting. Over 50% of those
who report depression or mood affective disorders, heart disease, or mental and behavioural
disorders, as their main condition are not in the workforce.13 The probability of being out of
the workforce by main chronic condition is shown in Figure 4.
6
Figure 4: Probability of being out of the workforce by main chronic

condition
Hypertension 1.29
Diabetes 2.52
Heart disease 4.21
Depression or mood affective disorders 6.71
Mental and behavioural disorders 5.71
Arthitis 3.06
Back problems 3.59
Asthma 1.44
0 1 2 3 4 5 6 7
Odds ratio of being out of the workforce.

The reference group was "no chronic condition"
Source: Schofield14
This association between chronic conditions and lower workforce participation is also
apparent outside of Australia.15 A cross-sectional analysis of 16 European countries
concluded that poor health was associated with early retirement and unemployment, and that
chronic conditions such as depression, diabetes, lung disease, back problems or arthritis
were more prevalent in unemployed and retired people.16
2.2 Trends and projections
Trends and projections indicate that health will continue to be a critical determinant of
workforce participation. As a result, chronic conditions are likely to place pressure on
achieving the goal of longer working lives.
Based on current health trends AMP.NATSEM modelling predicts that in 2035 one in four
men and more than one in five women in their sixties will have a self-reported health status
of fair or poor, with the majority of this group 65.1% of men and 72.1% of women, likely to
be unemployed.17
Table 1 shows the projected increase in both the number of older people out of the workforce
for health reasons, and in the number of older people employed with a chronic condition, with
both groups exceeding total population growth.
Table 1: Workforce status of Australians aged 45-64 years projected to 2030
Workforce status 2010 2030 Growth (%)
Employed with a chronic 2,073,000 2,850,000 37.5%

condition
Employed without a chronic 2,073,000 2,705,000 30.5%

condition
Out of the workforce for 347,000 459,000 32.3%

health reasons
7
Out of the workforce for other 1,086,000 1,116,000 2.7%

reasons
Total working population 5,580,000 7,130,000 27.8%
Source: Schofield18
The main chronic conditions implicated in these projections are likely to remain similar to the
current most prevalent conditions, although there are notable increases in the rate of
diabetes and chronic pulmonary obstructive disease. The projected prevalence of chronic
conditions in 2030 compared to 2010 is shown in Figure 5.
Figure 5: Main chronic conditions of people aged 45-64 years not in

the workforce for health reasons in 2010 and 2030
Back problems 79,000

96,000
Arthritis 45,000
60,000
Mental and behavioural disorders 32,000

43,000
2010
Depression 24,000
28,000 2030
Diabetes 14,000
22,000
Chronic pulmonary obstructive disease 8,000

14,000
0 20,000 40,000 60,000 80,000 100,000

Number of people
Source: Schofield19
The projected growth in chronic disease prevalence is underpinned by adverse health and
lifestyle trends such as physical inactivity and poor nutrition. Without prevention and
intervention strategies by Government, business and individuals, these adverse health
trends, coupled with population ageing, will lead to increasing numbers of people with
chronic conditions.20
2.3 The impact of ageism and negative assumptions
Motivation and capacity to stay in the workforce are not simply products of age. External
factors such as organisational support and access to health care play an important role. In
this way age discrimination, ageist assumptions and negative stereotypes can undermine the
ability or desire of an older person to remain in the workforce.
Age discrimination does occur in the workplace. The national prevalence survey showed that
over a quarter of Australians aged 50 years and over reported experiencing some form of
age discrimination in the last two years.21
8
Discrimination may be direct or indirect and can be related to negative stereotypes,

misunderstanding of illness or disability, and/or of legal responsibilities.
Negative stereotypes and ageist assumptions can inform the way colleagues and employers
treat older people in the workplace. These assumptions can be that older people are frail,
weak and in poor health, and that they are not willing to learn or motivated to stay in work.
The Commissions Fact or Fiction? Stereotypes of Older Australians Report confirmed that
along with feelings of shame, sadness and anger, being subject to negative stereotypes
directly impacts on personal perceptions of self-worth and the persons own view of ageing.22
Such attitudes also negatively impact the way an older worker is supported within an
organisation. In particular, it can manifest as an unwillingness to offer support and adequate
workplace adjustments or an eagerness to remove an older person from the organisation.
Furthermore, age discrimination and ageist assumptions undermine the crucial relationship
between employer and employee. Consequently, where age discrimination occurs it can lead
to an employee avoiding disclosure of a chronic condition, not accessing support or not
wanting to stay in work.
For example, Arthritis Victoria found that disclosure avoidance was reported by participants
who expected to be discriminated against because of their condition, or who perceived no
advantages in disclosing.23 Furthermore, many participants were concerned that accessing
workplace supports would single them out as being a liability to the work team or
organisation.24
A literature review by the Victorian Department of Health in 2012 also noted that [ageism]
can limit access to health care, due to beliefs that health problems are just a normal part of
ageing.25 Preventative health care and proper management of chronic conditions is crucial to
supporting longer working lives and so where adequate health care is not accessed the
probability of remaining in the workforce is reduced.26
3 The case for wellbeing and longer working lives
3.1 Government
Increasing workforce participation by older people and achieving longer working lives is one
way of meeting future challenges brought on by demographic changes.
As stated by the most recent intergenerational report: to drive higher levels of prosperity
through economic growth, we must increase productivity and participation. If we are to
achieve these goals we need to encourage those currently not in the workforce, especially
older Australians and women, to enter, re-enter and stay in work, where they choose to do
so.27
Government policy specifically aimed at improving health and wellbeing as means of

extending working lives is an important policy lever in terms of improving participation rates,
increasing GDP and tax revenue and also reducing expenditure.
Without the capacity to work as a result of poorly managed health, financial incentives can be
underutilised. This is because once an individuals choice is removedthe classical life-
cycle trade-off between an increase in future income and leisure as a determinant of
retirement becomes irrelevant.28 For people who retire involuntarily as a result of ill-health,
changes in the age pension eligibility or other incentives for continued work will have no
impact on their effective retirement age but can have an impact on their wellbeing at
retirement.29
9
Therefore, improving health and wellbeing can enhance the effectiveness of other policies
aimed at increasing workforce participation by older people. For example AMP.NATSEM
suggests that a small improvement in population health could achieve a similar increase in
workforce participation as raising the age pension eligibility age, but in a shorter period of-
time.30
Health, as shown in Figure 6, is a significant influence on retirement intentions. ABS data

shows that health, as the main factor influencing the decision about when to retire is second
only to financial security, and is a more significant factor than reaching eligibility for age
pension. This adds weight to the potential of health as a policy lever to raise workforce
participation.
Figure 6: Selected main factor influencing decision about when to

retire for people over the age of 45 who have not yet retired
Have more leisure time 3.0
Need to care for partner or family 1.5
Personal health or physical abilities 23.2
Financial security 37.7
Access to superannuation fund 3.3
Reaching the eligibility age for age pension 13.2
0.0 10.0 20.0 30.0 40.0

Percentage (%)
Source: ABS31
Improving health is also a means of improving economic sustainability. The national cost of
chronic conditions as a result of reduced workforce participation, shown in Figure 7, is
significant this is both as a result of extra Government transfer payments and lost taxation
revenue. For example, reduced workforce participation as a result of back problems in those
aged 4564 years incurs an estimated loss of $497 million in taxation revenue and an extra
$622 million in Government spending through transfer payments.
10
Figure 7: National Costs of Chronic Conditions as a result of reduced

workforce participation
700
622
600
497
500
394 407
$Million
400 Extra Government Spending

291 278 through transfer payments
300
225 Lost taxation revenue
200
85
100
0
Back problems Arthritis Mental Health Cardiovascular
Conditions Disease
Source: Schofield32
As shown in Figure 8, projections indicate that the cost of lost workforce participation due to
chronic conditions in people aged 4564 years will continue to be large, with lost GDP being
over $60 billion by 2030. This is particularly critical in the context of a shrinking workforce
and increasing pressure on economic sustainability.
Figure 8: Projected GDP lost due to reduced workforce participation
of older people with chronic condition (2010 to 2030)
70 63.7
60 56.4
50.5
Lost GDP $Billion
50 44.5
37.8
40
30
20
10
0
2010 2015 2020 2025 2030
Source: Schofield33
The importance of health as an enabler of workforce participation, along with the large
national cost of chronic conditions adds to the national impetus to reduce prevalence of
chronic conditions and create more work-enabling environments.
3.2 Business
There is a strong case for business to promote the health and wellbeing of its employees.
The workplace is therefore not only a key facilitator of healthy ageing, but is also a central
beneficiary.
Research has shown that workplaces with formal health and wellbeing programs have a
competitive advantage, reporting tangible gains in productivity, employee satisfaction and
engagement.34
11
Furthermore, the cost of employees in poor health is significant. Employers bear the cost of
poor health through increases in both absenteeism and presenteeism (not fully functioning
at work as a result of a medical condition). The AIHW reports that those with chronic
conditions have 0.48 days off per fortnight due to sickness compared to 0.25 days for people
without a chronic condition.35 The estimated cost of absenteeism to the Australian economy
is $7 billion, while the cost of presenteeism is nearly four times more.36
In 2008 a review of 55 organisations in the UK by PwC found that 45% of those with health
and wellbeing interventions experienced reductions in absenteeism. The same review also
found improvements in staff turnover, employee satisfaction and a decrease in accidents and
injuries.37
Demographic changes and the desire to increase workforce participation of older people
increases the imperative for business to support health and wellbeing. Supporting the health
and wellbeing of employees is crucial in retaining older workers for two reasons:
Firstly, because health is such a prevalent factor in retirement decisions and chronic
conditions can so often be the cause of early workforce exit, promoting good health
and preventing risk factors are crucial aspects of retaining experienced, highly skilled
older employees.
Secondly, health and wellbeing measures tend to increase employee satisfaction.

This is important in terms of retaining older employees, as those who stay in paid
work later in life tend to be those who enjoy their work.38
3.3 Individuals
Being able to work for as long as you wish to do so is an important determinant of wellbeing.
Fulfilling employment can have psychological benefits, flowing on to physical benefits and
also contributes to financial security.
Conversely where health becomes a limitation on the ability of a person to remain in work,
involuntary retirement or unemployment, underemployment and stressful working conditions
can be detrimental to wellbeing. It is therefore important for individuals to recognise that
establishing a good health trajectory is crucial to being able to continue in work for as long as
they wish to do so.
ABS data indicates that, regardless of their health status, people want to continue in work
beyond 60 years old.39 However, as AMP.NATSEM reports those in fair or poor health are
unlikely to remain in the workforce for this long (see: Figure 1). This disconnect indicates that
in the future an increasing number of people who would like to work will not be able to do so
as a result of their health.
The prevalence of own sickness, injury or disability being cited as a reason for retirement
shows the impact health can have on workforce participation. In the most recent ABS survey,
this was cited as the second most common reason for retirement behind reaching eligibility
age for superannuation or pension. Furthermore, where those who retired aged 55 years or
less are specifically considered own sickness, injury or disability is by far the most common
reason at 20% (Figure 9a).
12
Figure 9: Selected reasons for retirement of people aged 45 years and

over who have retired
4.3
To care for ill/disabled/elderly person
1.7
13.8
Own sickness, injury or disability
19.1
Reached retirement age/eligible for 18.9

superannuation/pension 36.8
2.7
Temporary/seasonal/holiday job
1.9
5.3
Retrenched/dismissed/no work available
9.1
0.0 10.0 20.0 30.0 40.0

Female Male
Percentage (%)
40
Source: ABS
Figure 9a: Selected reasons for retirement of people aged 45 years
and over who have retired
70.0
58.1
60.0
Percentage (%)
50.0 41.7
40.0
30.0 25.9
20.0 18.5
20.0 14.4
7.2 9.5 8.7 7.4
10.0 4.7 3.1
0.0
Less than 55 years 55-59 years 60-64 years 65-69 years
Age at retirement
Retrenched/dismissed/no work available

Reached retirement age/eligible for superannuation/pension
Own sickness, injury or disability
Source: ABS41
In addition, in the same ABS survey those who cited own sickness, injury or disability had
on average the earliest retirement age, being 53.0 and 54.9 years for women and men
respectively.
13
Figure 10: Age at retirement by selected reason for retirement
To care for ill/disabled/elderly person 53.7

59.6
To have holiday/pursue leisure activities 54.8

61.0
Own sickness, injury or disability 53.0

54.9
Reached retirement age/eligible for 61.9

superannuation/pension 64.1
Temporary/seasonal/holiday job 59.2

65.7
Retrenched/dismissed/no work available 57.0

59.2
50.0 54.0 58.0 62.0 66.0

Age at retirement (years)
Female Male
Source: ABS42
The financial implications of early and involuntary retirement are also significant. Financially
individuals with poorly managed health conditions face a double jeopardy in the sense that
they face extra costs associated with poor health and also worse employment outcomes.
AMP.NATSEM have reported that poor health will prevent one in four Australians from
saving enough for retirement.43 Further, income, wealth and superannuation have been
shown to be greatly lower for those that exit the workforce prematurely, with previous studies
showing that households forced to take retirement due to a shock such as illnessfare
much more poorly in retirement and have a much greater drop in their standard of living post-
retirement than those that have a planned, voluntary retirement.44
Figure 11: Median total wealth of people aged 45 - 64 years by
chronic condition
300,000
$255,199
250,000
$212,809
Total wealth ($)
200,000
$157,600
$148,000
150,000 $138,147
$112,315
100,000
50,000
0
Employed full- NILF due to NILF due to NILF due to NILF due to NILF due to
time, no depression other Mental back pain cardiovascular arthritis
Chronic Illness disease
Condition
Source: Schofield45
14
These indirect costs are on top of the direct financial costs of ill-health, which can often be
very significant. Furthermore, people with multiple chronic conditions tend to experience
greater financial loss.46
Figure 12: Total median wealth of people aged 45 - 64 years by
number of chronic conditions
300,000
$255,199 $253,700 $246,200
250,000
Total wealth ($)
200,000
$170,800
$150,200
150,000
100,000
50,000
0
No chronic One chronic Two chronic Three chronic Four or more
condition condition conditions conditions chronic conditions
Source: Schofield47
Together this information highlights that while many people intend to have working lives
beyond the age of 60, whether or not they will be able to is likely to be influenced by their
health status. Furthermore, where people retire prematurely and/or unexpectedly it is often
financially and psychologically detrimental.48 On the other hand well-managed health can
enable people to have more control over employment and retirement decisions, and also
support better overall wellbeing. Individuals should therefore, consider their health as an
essential aspect of achieving a longer working life.
3.4 International examples
The importance of healthy ageing is gaining international significance and is evident in

policies in numerous countries. Often the policies involve improving workplace wellbeing and
the quality of job design as a means of increasing workforce participation by older people.
There are a number of notable examples of existing policies and also numerous reviews that
have sought to encourage reform towards healthy ageing. Some interesting aspects of
certain policies include the joint implementation by various government agencies, significant
public promotion campaigns and also targeting of progressive businesses in initial phases.
Two notable examples are described below.
One international example of using health policy as a means of increasing workforce

participation was the national program on ageing workers in Finland implemented from 1998
to 2002.49 This program was implemented jointly by the Ministry of Social Affairs and Health,
the Ministry of Labour and the Ministry of Education and covered information campaigns,
research projects, and specific programs to increase the work-ability of older people.
The sustainable employability initiative in the Netherlands50, launched in 2012 is an initiative

led by the Ministry of Employment and Social Affairs to promote direct dialogue with
hundreds of employers and workers on how to maintain employability. The goals of the
initiative are to prevent unemployment and sickness, improve the productivity of all workers,
and develop networking activities on health. In its initial phase the initiative encouraged
voluntary participation by innovative firms or those undergoing dynamic changes, with the
15
idea that these firms would then encourage participation of other firms by disseminating
examples of best practice.
4 What can be done to facilitate longer, healthier working lives?
There is a clear impetus for government, business and individuals to improve health and
wellbeing as a means of ensuring longer and more productive working lives. This section
discusses way to facilitate longer, healthier working lives and in particular raises five
recommendations for change.
As chronic conditions are often related to reduced workforce participation and premature
retirement it is necessary to promote existing strategies and develop new ones to reduce the
prevalence of chronic conditions in the future.
Adverse health trends in disease risk factors, particularly increases in obesity, poor nutrition
and physical inactivity, underpin the prevalence of chronic conditions. This presents an
opportunity for targeted, proactive health strategies to curb increases in disease risk factors.
Promotion of wellbeing in the workplace will be explored further in this paper as a means of
reducing the prevalence of chronic conditions.
The other aspect that will be outlined is promoting accommodations in the workplace. This is
a key aspect of facilitating longer working lives because reduced workforce participation is
not an inherent or inevitable consequence of having a chronic condition, rather it is strongly
influenced by external factors, in particular organisational support.
The main policy challenges are to join up existing initiatives, invest in those that deliver the
best results and make it easier for all stakeholders to engage with and contribute to health
ageing in a sustained way. A national strategy that encompasses these two aspects of
healthy ageing could outline the overarching plan and set clear objectives required to
overcome existing challenges.
Recommendation 13: That the Australian Government develop and implement a national
healthy ageing strategy to promote evidence-based preventative health practice
particularly in the employment context, and improve access to workplace adjustments.
This strategy is to be supported and overseen by an expert advisory panel. As part of this
strategy the government will actively engage industry groups, peak bodies and trade
unions.
4.1 Public education campaign - reinforcing the importance of healthy ageing
Engagement of all stakeholders is imperative to achieving healthy ageing. Government has a

crucial role in broadly making the case for wellbeing to business and individuals. To facilitate
changes in behaviour it is necessary for the Government to reaffirm the importance of this
long-term change and to exhibit its sustained commitment to healthy ageing initiatives.
Public health campaigns and the promotion of good health through a variety of policies
clearly have a role in engaging all stakeholders with the healthy ageing agenda. In Australia
there have been a number of public health campaigns that have promoted the importance of
good health, including better nutritional choices and regular physical activity.51
In the context of aiming to increase workforce participation by older people a worthwhile

government investment would be to establish a public health campaign that more specifically
showcases the importance of healthy ageing and the means through which it can be
achieved. This would include emphasising the benefits to overall wellbeing of meaningful
16
work and regular exercise. Building a broad community awareness of the importance of
healthy ageing will support broader elements of healthy ageing policy and in particular
enhance business engagement with the message.
A campaign specifically targeting older people could also be useful as some risk factors,
including physical inactivity are particularly problematic amongst this age group61.6%
males and 62.6% females aged 45-54 do not undertake sufficient physical activity.52
Recommendation 14: That the Australian Government develop a national public

education campaign that reinforces the importance of healthy ageing, and in particular,
emphasises the relationship between health and work.
4.2 Facilitating good health in the workplace
The workplace is a key avenue for the prevention of chronic conditions and overall promotion
of good health. As described earlier, there is also a strong case for business to invest in
health and wellbeing programs.
From the perspective of Government, it is therefore important to encourage and support

effective, evidence-based health and wellbeing initiatives in all workplaces, including both the
public and private sector, through the provision of incentives and also information to make
implementation easier. In particular, it is crucial to specifically consider incentives to attract
SME.
Currently the Government provides financial incentive for businesses to provide on-site
fitness services through a fringe benefits tax exemption. Financial incentives are important as
budgetary constraints are often cited as a barrier to implementation of such initiatives.
A possible way to enhance this incentive, and make it more accessible to SME (which is
unlikely to have on-site fitness services) is to extend the tax exemption to off-site fitness
services. More information about this proposal can be found at www.fitnotfbt.org.au/.
There is also scope to more thoroughly investigate a range of worthwhile health and
wellbeing initiatives both new and existing, to ensure that health and wellbeing programs
provided in the workplace are effective and suitable to all employees, including those with
existing chronic conditions.
Specialised exercise programs for people with chronic conditions can improve exercise
capacity, wellbeing and reduce absenteeism and hospital admissions. Extending the
Medicare benefits scheme to cover these sorts of programs is important to provide greater
access to effective exercise programs that can also be promoted through the workplace.
Recommendation 15: That the Australian Government investigate the provision of tax or
other financial incentives to encourage business and employers to adopt health and
wellbeing initiatives e.g. extend the fringe benefits tax exemption to off-site fitness
services, and broaden the Medicare benefits scheme to exercise programs for people with
chronic conditions.
The Government also supports wellbeing in the workplace through disseminating information
and ensuring that the Australian Public Service is a model employer. The Investing in
Experience: Working for Today53 model specifically promotes health, safety and wellbeing in
the workplace as a means of facilitating longer working lives. In particular, the focus is to
emphasise the crucial role that workplaces have in facilitating health of employees and
provides practical guidance to more effectively recruit and retain older workers. This
17
Comcare program is connected to the APS 200 Project: Work Ability and Ageing Framework
for Action that was endorsed in 2012 by the APS Secretaries Board.
Until 201454 the Australian Government had a broad healthy workers initiative under the
National Partnership Agreement on Preventative Health. The partnership was agreed by the
Council of Australian Governments in 2008 with the aim of facilitating preventative health
strategies in various settings, including the workplace. Through this the Government invested
in partnerships with state governments and established the healthy workers portal
(www.healthyworkers.gov.au) which, provided information about the case for wellbeing and
examples of good practice. Despite the federal Government initiative being discontinued a
number of state-based initiatives have continued.
Reinvesting in an initiative similar to healthy workers, that is focussed more specifically on

healthy ageing and includes strategies around workplace accommodations as well as
preventative health, would showcase the Governments commitment to healthy ageing and
also promote a more holistic and strategic national approach.
For this sort of initiative, a co-ordinated, cross-departmental effort is crucial to promote equity
and to capture the many areas where health is influential and can be influenced. Government
departments that may be involved could include the Department of Health, Department of
Employment, Department of Education and Training and Department of Social Services.
Recommendation 16: That the Australian Government establish and fund a healthy and
productive workers initiative, to be administered jointly by government departments
including the Department of Health and Department of Employment to actively promote
evidence-based workplace health programs, disseminate information and showcase good
practice.
In terms of business there are a number of steps that can be taken to help ensure health and
wellbeing initiatives implemented are successful. Engagement of staff and senior
management is crucial to the successful implementation. This can be facilitated through open
communication, involvement in decision-making by employees and training of supervisors
and management as to the importance of health.
It is also important for businesses to understand their workforce in order to develop effective
strategies, and to collect and evaluate data regularly to ensure sustainability. As noted on the
Healthy Workers website risk factors to chronic disease vary amongst industries, this
reinforces why it is important for businesses to have knowledge of their workforce.55
4.3 Organisational support and workplace adjustments
Organisational support is an important aspect of facilitating a longer working life, particularly

where an employee has a chronic health condition. Flexible work arrangements, adequate
workplace adjustments, good job design and a supportive manager are all elements that can
help a person with a chronic condition to remain employed.
As with wellbeing in the workplace the provision of effective and consistent organisational
support requires engagement of all stakeholders. The key policy challenge is to showcase
the power of organisational support and to make adjustments more accessible, in order to
promote more health and age friendly workplaces.
From a business perspective it is crucial to view the provision of organisational support

through the lens of improving the wellbeing of all employees to meet their needs and
optimise their contribution at work, rather than as a means of meeting legal requirements.
18
Where organisations move from an ad hoc to a more holistic approach the provision of
organisational support tends to be more effective because this approach necessitates an
attitudinal shift from asking why an employee needs support, to simply asking what they
need.
Qualities that contribute to more effective workplace adjustment procedures are formalised
policies, confidential and optional disclosure, supervisors receive appropriate training in
offering support and adjustments and there is a presumption in favour of work being flexible.
The Government currently supports the provision of workplace adjustment for employees
with disability through the Employment Assistance Fund (EAF). This is administered through
JobAccess, which is an information and advice service funded by the Australian
Government. The financial support provided by the EAF includes costs of workplace
equipment and modification for employees with a health condition that meets the EAF
guidelines.56
Given the impact of chronic health conditions on workforce participation, it is apparent that
more could be done through JobAccess and the EAF to facilitate the provision of workplace
adjustments specifically for older people with a chronic health condition to support their
continued participation in the workforce. Particular challenges to overcome may be that the
person with the chronic health condition and/or their employer are unaware of the supports
available or do not consider the condition to be a disability.
For example, the EAF could be extended to specifically include relevant training for
managers and co-workers, while the information service provided by JobAccess could more
explicitly outline supports that are available under the EAF for workers with a chronic health
condition.
Recommendation 17: That to support continuing workforce participation and to improve

access to workplace adjustments for people with chronic health conditions, the Australian
Government:
expand the Employment Assistance Fund to include training for managers and
co-workers about employees with chronic health conditions
develop information and resources provided by JobAccess that specifically
address workplace adjustments for employees with chronic health conditions
review the current EAF guidelines to ensure they do not exclude people with
chronic health conditions from accessing workplace adjustments.
Finally, individuals are a crucial stakeholder to engage. It is important for individuals to

consult with their GP and specialists, where necessary, to understand their health and the
workplace adjustments that can help them to stay in the workplace.
Along these lines the Australian Human Rights Commission has included information on
healthy ageing in the Skills Checkpoint pilot program being administered through the
Department of Education and Training. Specifically, this emphasises the importance of
properly managing and understanding health as a means of maintaining employment.
Proper management of conditions is critical to facilitate workplace participation. There may

also be scope to better equip GPs to support older workers with chronic health conditions,
and potentially for the Government to promote and invest more heavily in effective
preventative health and management strategies.
19
1 Australian Human Rights Commission, National prevalence survey of age discrimination in the workplace (2015)
16 available at http://www.humanrights.gov.au/our-work/age-discrimination/publications/national-prevalence-
survey-age-discrimination-workplace
2 Deborah J Schofield, Rupendra N Shrestha, Megan E Passey, Arul Earnest and Susan L Fletcher, Chronic
disease and labour force participation among older Australians (2008) 189 and 8 Medicine and the Community
447, 447.
3 AMP.NATSEM, Going the distanceWorking longer, living healthier, AMP.NATSEM Income and Wealth Report
Issue No 37 (2015) 18.

4 Reproduced from AMP.NATSEM, Going the distanceWorking longer, living healthier, AMP.NATSEM Income
and Wealth Report Issue No 37 (2015) 18.

5 Seyed Mohammad Alavinia and Alex Burdorf, Unemployment and retirement and ill-health: a cross-sectional
analysis across European countries (2008) 82 Int Arch Occup Enviorn Health 39, 44.
6 S.W. Pit, R. Shrestha, D. Schofield, M. Passey, Partial and complete retirement due to ill-health among mature
age Australians (2013) 127 Public Health 561, 567.

7 Australian Institute of Health and Welfare, Chronic Disease and Participation in work (2009) 7.
8 Australian Institute of Health and Welfare, Chronic Disease and Participation in work (2009) 35.
9
Deborah J. Schofield, Rupendra N. Shrestha, Richard Percival, Emily J. Callander, Simon J. Kelly, Megan E.
Passey, Multiple chronic health conditions and their link with labour force participation and economic status
(2013) 8 and 11 PLoS ONE 1, 5.
10 Deborah J. Schofield, Rupendra N. Shrestha, Richard Percival, Emily J. Callander, Simon J. Kelly, Megan E.
Passey, Multiple chronic health conditions and their link with labour force participation and economic status
(2013) 8 and 11 PLoS ONE 1, 3.
11 Deborah J. Schofield, Rupendra N. Shrestha, Michelle Cunich, Robert Tanton, Lennert J Veerman, Richard
Percival, Emily J. Callander, Simon J. Kelly, Megan E. Passey, Productive Life Years lost due to chronic
conditions in Australians aged 45-64 years from 2010 to 2030: projections from a microsimulation model, (2015)
203 (6) MJA 206, 208.
447, 449.
447, 448.
447, 449.
15 AIST, Submission 329 to Australian Human Rights Commission, Willing to Work: National Inquiry into
employment discrimination against older Australians and Australians with disability, Annexure C, 16.
16 Seyed Mohammad Alavinia and Alex Burdorf, Unemployment and retirement and ill-health: a cross-sectional
analysis across European countries (2008) 82 Int Arch Occup Enviorn Health 39, 43.
17 AMP.NATSEM, Going the distanceWorking longer, living healthier, AMP.NATSEM Income and Wealth
Report Issue No 37 (2015) 27.

18 Deborah J. Schofield, Rupendra N. Shrestha, Michelle Cunich, Robert Tanton, Lennert J Veerman, Simon J.
Kelly, Megan E. Passey, Productive Life Years lost due to chronic conditions in Australians aged 45-64 years
from 2010 to 2030: projections from a microsimulation model, (2015) 203 (6) MJA 206, 208.
19 Deborah J. Schofield, Rupendra N. Shrestha, Michelle Cunich, Robert Tanton, Lennert J Veerman, Simon J.
Kelly, Megan E. Passey, Productive Life Years lost due to chronic conditions in Australians aged 45-64 years
from 2010 to 2030: projections from a microsimulation model, (2015) 203 (6) MJA 206, 209.
20 Australian Institute of Health and Welfare, Chronic Disease Australias Biggest Health Challenge (2014) 9.
21 Australian Human Rights Commission, National prevalence survey of age discrimination in the workplace
(2015) 1.
22 Australian Human Rights Commission, Fact or Fiction? Stereotypes of Older Australians (2013) 28.
23 Oakman, Briggs, Kinsman, Bywaters working with pain: What can workplaces do to support employees with
persistent musculoskeletal pain to maintain productive employment? (2015) Arthritis and Osteoporosis Victoria,
24
28.
25 State of Victoria Department of Health healthy ageing literature review (2012) 16.
29.
27 Commonwealth of Australia, Intergenerational Report 2015 iii.
20
30 AMP.NATSEM presentation to Australian Human Rights Commission.
31 Australian Bureau of Statistic, 2015, Retirement and Retirement Intentions July 2014 to June 2015, cat. no.
6238.0. At http://www.abs.gov.au/ausstats/abs@.nsf/mf/6238.0 (viewed 25 May 2016).

32 Schofield et al, The personal and national cost of early retirement because of spinal disorders: impacts on
income, taxes, and government support payments (2012) 12 the Spine Journal 1111, 1115; Schofield et al, The
personal and national costs of lost labour force participation due to arthritis: an economic study (2013) 13 BMC
Public Health 188, 194; Schoefield et al, The personal and national cost of mental health conditions: impact on
income, taxes, government support payments due to lost labour force participation (2011) 11 BMC Psychiatry 72,
79; Schofield et al, The personal and national of CVD: Impacts on income, taxes, government support payments
and GDP due to lost labour force participation(2013) 166 International Journal of Cardiology 68, 69.
33 Deborah J. Schofield, Rupendra N. Shrestha, Michelle Cunich, Robert Tanton, Lennert J Veerman, Richard
Percival, Emily J. Callander, Simon J. Kelly, Megan E. Passey, Productive Life Years lost due to chronic
conditions in Australians aged 45-64 years from 2010 to 2030: projections from a microsimulation model, (2015)
203 (6) MJA 206, 209.
34 The Work Foundation, the way forward: policy options for improving workforce health in the UK (2014) 13.
35
Australian Institute of Health and Welfare, Chronic Disease and Participation in work (2009) 17.
36 PricewaterhouseCoopers, Workplace Wellness in Australia (2010), i.
37 The Work Foundation, the way forward: policy options for improving workforce health in the UK (2014) 4.
38 AMP.NATSEM, Going the distanceWorking longer, living healthier, AMP.NATSEM Income and Wealth
Report Issue No 37 (2015) 11.





43 AMP, Poor Health will prevent one in four Australians from saving enough money for retirement:
AMP.NATSEM Report (Media Release, 10 June 2015) 1. At

http://media.amp.com.au/phoenix.zhtml?c=219073&p=irol-newsArticle&ID=2076394 (viewed 23 September
2015).
45 Schofield et al, Quantifying the effect of early retirement on the wealth of individuals with depression or other
mental illness (2011) 198 British Journal of Psychology, 123, 124; Schofield et al, Early retirement and the
financial assets of individuals with back problems (2011) 20 Eur. Spine Journal, 731, 734; Schofield et al,
Retiring early with cardiovascular disease impact on individuals financial assets (2010); Schofield et al
Labour force participation and the influence of having arthritis on financial status (2015) 35 Rheumatology
International, 1175, 1178.
46 Deborah J. Schofield, Emily J. Callander, Rupendra N. Shrestha, Megan E. Passey, Richard
Percival, Simon J. Kelly, Multiple Chronic Health Conditions and Their Link with Labour Force Participation and
Economic Status (2013) 8 and 11 PLoS ONE 1, 5.
47 Deborah J. Schofield, Emily J. Callander, Rupendra N. Shrestha, Megan E. Passey, Richard
Percival, Simon J. Kelly, Multiple Chronic Health Conditions and the link with wealth assets, (2014) European
Journal of Public Health 1, 3.
48 Associate Professor Pam McGrath, Submission No 124 to Australian Human Rights Commission, Willing to
Work: National Inquiry into employment discrimination against older Australians and Australians with disability, 2.
49 OECD, Ageing and Employment Policies: Live Longer, Work Longer (OECD Publishing, 2006), 131.
50 OECD, Ageing and Employment Policies: France 2014 (OECD Publishing, 2014), 169.
51 See for example: Department of Health, A Healthy and Active Australia. At www.healthyactive.gov.au/ (viewed
1 February 2016).
52 Australian Institute of Health and Welfare, Risk factors contributing to chronic disease (2012), 28.
53 Comcare, Investing in Experience: Working for Today and TomorrowInvesting in Experience. At
www.comcare.gov.au/promoting/investing_in_experience/a/investing_in_experience (viewed 1 February 2016).

54 Parliament of Australia, Healthy Funding AgreementsBudget Review 2014-15. At
www.aph.gov.au/about_parliament/parliamentary_departments/parliamentary_library/pubs/rp/budgetreview20141
5/healthfunding (1 February 2016).
55 Department of Health, Health WorkersHow Healthy is your Industry? At
www.healthyworkers.gov.au/internet/hwi/publishing.nsf/Content/industry (1 February 2016).

56 Department of Social Services, Employment Assistance Fund, Guidelines, Version 3.1, 3. At
http://www.jobaccess.gov.au/publication/employment-assistance-guidelines (viewed 8 April 2016).
21

Healthy Ageing Paper - May 2016 PDF

Загружено:

Сведения о документе

Оригинальное название

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Healthy Ageing Paper - May 2016 PDF

Загружено:

Авторское право:

Доступные форматы

National Inquiry into Employment

Discrimination Against Older Australians

and Australians with Disability

ABN 47 996 232 602

Significantly, current evidence shows that:

Recommendation 14: That the Australian Government develop a national public

Recommendation 17: That to support continuing workforce participation and to improve

2 Health and workforce participation of older workers

Age, Gender, Health Status

2.1 The impact of chronic conditions on workforce participation

Co-morbidity of chronic conditions is a strong predictor of workforce participation, with the

Figure 3: Workforce participation of those with multiple chronic

Figure 4: Probability of being out of the workforce by main chronic

Heart disease 4.21

Depression or mood affective disorders 6.71

Mental and behavioural disorders 5.71

Back problems 3.59

Odds ratio of being out of the workforce.

2.2 Trends and projections

Table 1: Workforce status of Australians aged 45-64 years projected to 2030

Workforce status 2010 2030 Growth (%)

Employed with a chronic 2,073,000 2,850,000 37.5%

Employed without a chronic 2,073,000 2,705,000 30.5%

Out of the workforce for 347,000 459,000 32.3%

Out of the workforce for other 1,086,000 1,116,000 2.7%

Total working population 5,580,000 7,130,000 27.8%

Figure 5: Main chronic conditions of people aged 45-64 years not in

Back problems 79,000

Mental and behavioural disorders 32,000

Chronic pulmonary obstructive disease 8,000

0 20,000 40,000 60,000 80,000 100,000

2.3 The impact of ageism and negative assumptions

Discrimination may be direct or indirect and can be related to negative stereotypes,

3 The case for wellbeing and longer working lives

Government policy specifically aimed at improving health and wellbeing as means of

Health, as shown in Figure 6, is a significant influence on retirement intentions. ABS data

Figure 6: Selected main factor influencing decision about when to

Have more leisure time 3.0

Need to care for partner or family 1.5

Personal health or physical abilities 23.2

Financial security 37.7

Access to superannuation fund 3.3

Reaching the eligibility age for age pension 13.2

0.0 10.0 20.0 30.0 40.0

Figure 7: National Costs of Chronic Conditions as a result of reduced

400 Extra Government Spending

Secondly, health and wellbeing measures tend to increase employee satisfaction.

Figure 9: Selected reasons for retirement of people aged 45 years and

Reached retirement age/eligible for 18.9

0.0 10.0 20.0 30.0 40.0

Retrenched/dismissed/no work available

Figure 10: Age at retirement by selected reason for retirement

To care for ill/disabled/elderly person 53.7

To have holiday/pursue leisure activities 54.8

Own sickness, injury or disability 53.0

Reached retirement age/eligible for 61.9

Temporary/seasonal/holiday job 59.2

Retrenched/dismissed/no work available 57.0

50.0 54.0 58.0 62.0 66.0

3.4 International examples

The importance of healthy ageing is gaining international significance and is evident in

One international example of using health policy as a means of increasing workforce